By Nina Youngstrom, Managing Editor, (nyoungstrom@aispub.com)

Disruptive physicians — the kind who insult nurses, throw tantrums and toss scalpels around — have always been a problem for hospitals and their employees. But the threat is looming larger given new developments, such as mandates that call for greater physician-coder/nurse interaction on issues that aren’t purely clinical (e.g., present on admission (POA) reporting, hospital-acquired conditions payment restrictions, Medicare-Severity DRGs) and the government’s push to link quality and payment. It’s hard for a coder to team with a physician to make decisions about POA indicators if that particular physician tells the coder she’s incompetent. And the hospital may struggle to thrive under value-based purchasing if a physician’s contemptuousness leads to high nurse turnover.

As hospitals grapple with disruptive physicians, a new trend has emerged, making a stubborn problem even more resistant to improvement, says Pittsburgh attorney Henry Casale. Some disruptive physicians are trying to evade consequences for their behavior by claiming that they are not disruptive at all. Rather, they are whistle-blowers exposing hospital noncompliance and poor quality, but the hospital is trying to retaliate against their complaints by branding them troublemakers, he says.

“We are seeing this more and more,” says Casale, who is with the law firm of Horty, Springer & Mattern. “Disruptive physicians raise specious claims that have no validity in an attempt to justify their disruptive behavior. Hospitals want to know legitimate compliance concerns, but if there were never any underlying compliance concerns, then lodging fictitious complaints is just another act of disruptive behavior. It’s a very difficult issue, being made more complex and being obfuscated by claims that the disruptive behavior is part of some whistle-blowing activity.”

Notwithstanding the distraction, the urgency for a solution remains. The Joint Commission requires hospitals to manage disruptive physicians. The code of conduct that hospitals must adopt for Joint Commission accreditation includes a standard for providing a “culture of safety and quality.” That means “leaders set expectations for behavior” in the workplace, according to its Web site.

“Safety and quality thrive in an environment that supports working in teams and respecting other people, regardless of their position in the organization. Undesirable behaviors that intimidate staff, decrease morale, or increase staff turnover can threaten the safety and quality of care,” the Joint Commission says.

Given the stakes, hospitals should consider ways to help disruptive physicians change their behavior, experts say. One approach is to do what hospitals do for any other outlier: confront physicians with data. Physicians respond to concrete information, even if it is about their own behavior, says Miami psychologist Larry Harmon, Ph.D. He runs a teamwork improvement program for disruptive physicians around the country.

Disruptive physicians are the kind who make life miserable for the people with whom they work — their health care team — with belittling remarks (e.g., “Are you a moron?”), sarcasm (e.g., “It’s hard to believe you even have a nursing degree!”), yelling and screaming when things don’t go their way and throwing things around the room.

Some physicians behave this way partly because of the milieu in which physicians are trained and practice, Harmon says. “Learning medicine is not a team activity,” he says. “They spend much of their time learning technical skills, not teamwork skills.” Also, physicians are what Harmon calls “feedback starved.” The more prestigious the specialty (e.g., surgeons), the less likely someone will call the physicians on their behavior, he says. As a result, disruptive physicians may be highly skilled and passionate advocates for their patients, but nightmares as colleagues.

Physicians Respond to Feedback

So Harmon developed an educational program designed to get disruptive physicians to stop mistreating the health care team by giving them feedback they lack and helping them see themselves through other peoples’ eyes.

There are three phases. First, there is assessment. Harmon sends personal e-mail surveys to the people who work with the disruptive physician. They are asked to answer, anonymously, a series of motivating (positive) questions and discouraging questions.

Examples of positive questions: To what extent does the physician treat team members with respect? To what extent does the physician adapt to changing policies? To what extent does the physician respond to conflict by trying to work out solutions? To what extent does the physician handle difficult team members effectively? To what extent does the physician point out mistakes in a helpful way? To what extent does the physician communicate clear expectations?

Examples of discouraging questions: To what extent does the physician talk down to team members? Overreact when little things go wrong? Yell and swear? To what extent does the physician get sarcastic or angry when asked important questions?

Avoidance, Favorable Comments Most Effective

Harmon summarizes the responses from the physician’s team members and prepares a summary report and recommendations for the physicians. “Most [physicians] are surprised how negative the feedback is,” he says. However, hearing the truth about how they are perceived “is necessary to break through the denial and defensiveness and to help the physician understand that his or her behavior is having a negative impact on others.”

Disruptive physicians are particularly responsive to two kinds of feedback: (1) avoidance comments, such as when nurses state on the surveys that “I call in sick to work when I know you are scheduled [to perform] surgery” and “I am trying to get a job in another part of the hospital so I don’t have to work with you”; and (2) favorable comments, such as “You’re a great surgeon (even though I can’t stand working with you)” and “I would take my mother to you for surgery.” In other words, they are deprived of the compliments because of their demeanor.

Once all the feedback is in, Harmon analyzes it to home in more specifically on the disruptive physician’s problem behaviors. That way, education can be tailored to the physician. There are education modules on frustration management, conflict management, people management and time management. For example, a physician who yells and screams a lot probably has an anger management problem.

Physicians then watch a video tailored to the triggers of their disruptive behaviors. It’s designed to help the physicians change their behavior and work better as part of the health care team. They have to take an online test afterward to ensure they understood and absorbed the content, Harmon says.

Finally, Harmon monitors physicians for a year or so after the training to ensure the changes are sticking and bad behavior doesn’t re-emerge. “We do periodic surveys [of the health care team] until the physician had had a sustained period of improvement,” he says.

Harmon says that over the next five to 10 years, hospitals will emphasize “getting professionalism back. It will become routine.” In fact, medical schools are already are addressing the importance of giving behavioral feedback to doctors-in-training. Harmon provides his program to all the medical students at the University of Miami, Miller School of Medicine. “Periodically giving and receiving feedback” is essential, he says. “You can’t change what you don’t know.”

Reprinted from REPORT ON MEDICARE COMPLIANCE, the nation’s leading source of news and strategic information on false claims, overpayments, compliance programs, billing errors and other Medicare compliance issues.

Anger May Help Lawyers Win in Court, but Not at Home

by Steven Stosny (Published in the Legal Times, 5-19-97)

Among professionals, attorneys may be the most susceptible to anger and resentment problems that lead to diminished performance on the job, greatly increased risks to health and psychological well-being, and ultimately, to unhappiness at home.

Virtually all my non-court-ordered clients with anger problems are attorneys whose continual irritability has disrupted their lives, including a few judges who fear that their anger at attorneys will unfairly influence their rulings.

The high rates of divorce, domestic violence, and alcoholism among attorneys are indications of this susceptibility that may have more to do with habits of motivation and concentration than with the stress of the job.

The practice of law requires diligent attention to a great many details that are not inherently interesting. To sustain intense focus and adequate energy levels in the absence of interest/excitement, the brain often taps into its most accessible reserve of energy, one of the more than a dozen forms of anger/resentment.

In reviewing a dull document, for instance, the brain might look for something to get peeved at, which provides the energy and focus necessary to complete the task. The brain must find provocation, however obscure, for a dominant-submissive response that evokes fear of defeat, failure, or humiliation (or fantasies of victory and dominance) to get its jolt of focusing energy.

This innocent use of anger as motivation does nothing less than put the sense of self at stake even in the most mundane tasks. Repeated over time, the entire personality shifts to a defensive adjustment. Even trivial disappointments seem like failure and rejection when consumed in a joyless drive and surrounded by a moat of irritability.

Because it acts on the entire central nervous system as an amphetamine, anger arousal always ends in a physiological “crash,” often experienced as depression when the issues stimulating the anger remain unresolved. Think about it. The last time you got angry, you got depressed afterwards. The angrier you got, the more depressed you got. And that is merely the physiological response, even if you kept from doing something while angry that you were ashamed of, like hurting the feelings of someone you love.

To escape the pain of depression, the brain will look for excuses to get angry. Thus, anger springs a terrible addictive trap by providing immediate relief from the depressed mood that it eventually worsens.

Anyone can become an anger junkie, using some form of anger for:

o Energy/motivation. You can’t get going or keep going without some anger or irritation.
o Confidence, a stronger sense of self, you only feel certain when you’re criticizing someone or angry with someone.
o Anxiety reduction. Anger makes you feel more at ease, especially in new or uncertain situations.
o Relief of depression. You tend to need a morning jolt of anger.

The addicted brain compulsively justifies the anger it craves, ignoring all contrary evidence in the process. Thus, judgment and reasoning are greatly impaired during anger arousal. Failure to comprehend most relevant possibilities that justify anger. That’s why people justifying their anger can sound like alcoholics claiming that they drink for the unique nutritional value of booze.

Regardless of personal levels of intelligence, during anger arousal, we perform generally as if we have a learning disability. Laboratory experiments have shown that even subtle forms of anger impair problem solving and general performances.

In addition to increasing error rates, anger narrows and rigidifies mental focus, obscuring alternative perspectives. The angry person has one “right way” of doing things, which, if selected in anger, is seldom the best way.

With the lone exception of hurting someone, there is nothing you can do angry–or resentful, irritable, grouchy, impatient, or chilly–that you can’t do better not angry.

Health Risks

The effects of anger on health have more to do with duration than with frequency and intensity. The normal experiences of overt anger lasts only a few minutes. But the subtle forms of anger–resentment, impatience, annoyance, irritability, grouchiness, and “attitude”–can go on for days at a time. The effects of anger on health have more to do with duration than with frequency and intensity. The normal experiences of overt anger lasts only a few minutes. But the subtle forms of anger–resentment, impatience, annoyance, irritability, grouchiness, and “attitude”–can go on for days at a time. A person with continual episodes of anger has a five-time greater chance of dying before age 50. Anger elevates blood pressure, increases threat of stroke, heart disease, cancer, depression, and anxiety disorders, and in general, depresses the immune system (angry people have lots of little aches and pains or get frequent colds and bouts of flu, headaches, or upset stomachs.)

To make matters worse, angry and resentful people tend to seek relief from their ill moods through other health-endangering habits, such as smoking and drinking, or through compulsive behavior such as workaholism and perfectionism.

A person with continual episodes of anger has a five-time greater chance of dying before age 50. Anger elevates blood pressure, increases threat of stroke, heart disease, cancer, depression, and anxiety disorders, and in general, depresses the immune system (angry people have lots of little aches and pains or get frequent colds and bouts of flu, headaches, or upset stomachs.)
To make matters worse, angry and resentful people tend to seek relief from their ill moods through other health-endangering habits, such as smoking and drinking, or through compulsive behavior such as workaholism and perfectionism.

According to Professor Arthur Miller of Harvard University Law School, good attorneys make opposing arguments seem like rank obscenities. This might be sound strategy in the courtroom—it may also explain why my clients who are judges see lawyers as impediments to their work—but it creates disaster in attachment relationships.

The formula for success in love relationships is quite the opposite: Validating the perspective of loved ones must precede disagreement. In fact, disagreement is not nearly as important as validation of emotions. People get the angriest, which means the most hurt, not about getting their own way, but when they feel misunderstood or disregarded by loved ones.

If adversarial skills work at all in the home they must be applied first to the building the case of loved ones, then fairly and compassionately comparing it to your own.

Winning is a goal for the courtroom, but in families, it causes only resentment, covert hostility, and intimacy barriers. Virtually every sexual problem I have ever seen in couples has its roots in resentment. When one person in a family wins, everybody loses.

A common myth about anger problems is that they only involve hurting someone or destroying property. But this is only one of dozens of kinds of anger problems. You have an anger problem if some subtle form of anger/resentment—that you might not even be aware of—makes you do something that is not in your best interest or keeps you from doing what is in your best interest.
This could be simply putting a chilly wall between you and your loved ones, or a continual impatience that keeps you from noticing the compassion of others.

Practitioners most vulnerable to anger/resentment problems are the most actively adversarial, in general, trial lawyers.

Next are those faced with job insecurity on top of highly stressful work conditions: associates in general and partners in struggling firms. Lawyers with poor social supports and family problems and those who must fight invisible barriers of sexism and racism are also highly vulnerable.

To assess your risk of developing an anger/resentment problem, ask yourself: “Do my emotional responses seem like the fault of someone else? Does it seem that other people are trying to ‘push my buttons?’ Is the first thing that occurs to me when a problem arises ‘Who’s to blame?’ or ‘How do I get even?’”

Archie Bunker: What’s wrong with revenge? That’s the perfect way to get even.
        - Norman Lear

Emotional Intelligence and Anger.

The real test of our ability to understand, respond to, and manage our emotions is the way we handle anger.

1.  Do we use it in productive or counter-productive ways?

2.  Does our anger lengthen or shorten our lives?

There are several important things to remember when speaking of anger.

Anger is:

•  A powerful survival tool.
•  A source of energy.
•  A secondary emotion.
•  When angry, our brain “downshifts” to the primitive and instinctual level preparing for “fight, flight or freeze” response and higher level thinking momentarily ceases.
•  Anger that lasts for a long time is harmful.
•  Anger held-in is also very unhealthy.
•  Anger is a universal emotion everyone shares.

Anger is an Energizer. Anger is a natural emotional state and is designed to help us stay alive. Anger sends signals to all parts of our body to help us fight. It energizes us and prepares us for action. Often, the perceived need to protect ourselves comes from what amounts to psychological attacks from others.

Use Anger Wisely. When we feel energized by anger, it is smart to ask ourselves how we put this energy to its most productive use. How we wish to channel this energy. As with the use of other forms of energy, we want to use anger effectively and efficiently, not wastefully.

Anger is a Secondary Emotion. Beneath anger is always a primary emotion, such as fear, frustration, or sadness. The primary emotion comes from an unmet need. Our anger can become a signal to look for our unmet needs and care for them.

Anger – Its Role.

Anger, as a secondary emotion, rises out of some primary emotion, such as fear or loneliness, that signals an unmet human need, such as the need for connection.

Anger – The Visible Emotion.

Anger tends to feel powerful at the time. It gives us an illusory sense of control. It blinds us to our primary emotions, since they tend to feel weak and uncomfortable. We rarely notice what lies
beneath our anger.

Primary Emotions Are Signals.

We rarely notice our primary emotions. We quickly move through them and into anger. Becoming aware of our primary emotions gives us the choice of proceeding to anger or examining our needs.

“Negative” Primary Emotions.

When we feel angry, our primary emotions are “negative” emotions. “Negative” means that they come from unmet needs: An unmet need for connection to other people may give rise to loneliness, a negative emotion.

“Positive” emotions come from fulfilled needs: When our need for connection is fulfilled, we may experience happiness or love, both positive emotions.

Working Effectively with Primary Emotions.

By ignoring our primary emotions and emotional needs, we may actually move further from fulfilling them: If we act out our anger, we tend to push others away from us. This leaves our need for connection unfulfilled and increases our loneliness. If we look beneath our anger, we can discover what we need and work to get our needs met: realizing that we need to connect, we can use appropriate communications to connect with a friend, or we can learn to soothe ourselves with self-talk, taking care of our unmet needs.

Unmet Needs – The Root.

By understanding our unmet needs we can develop a strategy to fulfill them. We can share them with people who are close. We can work to calm ourselves, self-soothe, to help ourselves positively instead of acting out.

Unmet Needs – A Time To Heal.

Often, when using the Anger Log, ABCD process (Beliefs, Feelings, Actions, Dispute), we discover that our beliefs are immature: “I want to do what I want to do, and I get angry when anybody gets in my way or I don’t get my way!”

If we don’t act out our anger, we practice changing our old habits by using self-control. We develop maturity! By using the Anger Pyramid to discover and fulfill our needs, we demonstrate to ourselves and others, our growth and maturity and we discover inner resources – strength, self-confidence, and trust in our abilities to cope with situations and other people. We discover more reasons to be positive and fewer reasons to act out.

Tom Wentz, Ph.D., C.A.M.F.
Faculty Member, Anderson and Anderson

“Just because a man lacks the use of his eyes doesn’t means he lacks vision.”
                                             – Stevie Wonder

Emotions Are Important. Our emotions are a critical source of information. Our emotions are necessary for us to make decisions. Studies show that when a person has an accident in which those structures of the brain that deal with emotions is damaged the  person cannot make even simple decisions. Why? Because the person has lost the capability to feel and thus, evaluate their decision. Social Neuroscience has demonstrated cognition requires emotion in order to complete the transaction of the decision-making process. Without emotion, cognition remains incomplete and unfulfilled.   

Our Bodies Talk. Our emotions help us communicate with others. Our facial expressions, for example, can convey a wide range of emotions. If we look sad or  hurt, we are letting the other person know that we need their help. If we are verbally skilled we will be able to express more of our emotional needs and thereby have  a better chance of filling them. If we are good at listening to the emotional needs of others, we are better able to help them feel understood, important, and cared about. The emotionally intelligent person is able to read, with some accuracy, the feelings conveyed non-verbally by those with whom he or she interacts.

Stress Reduces Our Ability to Feel. As our society has become more pressured and we are constantly overwhelmed by stress, our ability to recognize and respond to our own feelings and those of others is diminished. Overwhelming feelings of stress result in a reduced ability to manage intense feelings and an increase in stress-related disorders. Consequently, there is an increase in road rage, desk rage, air rage, voice-mail rage, verbal and physical aggression, violence against  others, substance abuse, and other inappropriate displays of anger.

Emotions Bring People Together. Our emotions are perhaps the greatest potential source of uniting all members of the human race. This is what makes us human and creates the potential for our humanity. Clearly, our various religious, cultural and political institutions have not united us. Far too often, in fact, they have even divided us. Emotions, on the other hand, are universal.

Emotions are Universal. The emotions of…

• Empathy - The ability to understand and share someone else’s feelings.

• Compassion - The ability to care about and give to someone else.

• Cooperation - The ability to work together to achieve a common goal.

• Forgiveness - The ability to pardon someone for a grievance against you or against someone one or
  something you care about.

All of these emotions have the potential to unite us as people. Our thoughts may tend to divide us, whereas our emotions, if given the chance, will unite us in our humanity.

Tom Wentz, Ph.D., CAMF
Faculty, Anderson & Anderson®
Trusted Name in Anger Management

“A universal trigger for anger is the sense of being endangered. Endangerment can be signaled not just by an outright physical threat but also, as is more often the case, by a symbolic threat to self-esteem or dignity: being treated unjustly or rudely, being insulted or demeaned, being frustrated in pursuing an important goal.” (Goleman, 1995)

Emotional intelligence is a relatively recent concept, which is related to the ability to understand one’s own feelings and behavior as well as the capacity to sense the feelings and needs of others and to utilize this information in a way that enhances interpersonal relationships. Emotional Intelligence is also the capacity to create positive outcomes in our relationships with others and ourselves. Positive outcomes include joy, optimism, and success in work, school, and life. Increasing emotional intelligence has been correlated with better results in leadership, professional and academic, performance, marriage, friendships, and overall health.

Recognizing as well as understanding our feelings and emotions and then, managing their impact on other people must be practiced to internalize the skills being taught. We believe that it is important to take an interest in people and learn to listen to their views, problems and concerns. As previously learned in The Practice of Control, listening is important in communication and is a skill that can be learned as well as improved upon.

Emotional intelligence (EI) encompasses four domains:

   1.  Self-Awareness.
    2.  Self-Control.
   3.  Social-Awareness.
   4.  Relationship Management.

Self-awareness facilitates both empathy and self-control. Empathy and self-   control combine to provide effective relationship management.

Self Awareness is the Foundation. Without self-awareness, we cannot be aware of our emotions. We cannot manage emotions we are not aware of, so our emotions will tend to be out of control. Out of control emotions impair our ability to experience empathy and to connect with others. When our emotions are out of control, our relationships suffer – we do not have social awareness or the ability for social management.

Emotions Are Our Guidance System. Nature developed our emotions over millions of  years of evolution. As a result, our emotions have the potential to serve us today as a guidance system. Our emotions let us know when any natural human need is not being met. For example, when we feel lonely, our need for connection with other people is unmet. When we feel afraid, our need for safety is unmet. When we feel rejected, it is our need for acceptance that is unmet.

Perception Is Everything. The way we appraise (see) our environment at any given time is important in determining how we respond emotionally. If we appraise a situation as a threat, put-down, or an insult, we are more likely to respond with anger and negativity.

Thomas L. Wentz, Ph.D., C.A.M.F.
Faculty, Anderson and Anderson Anger Management

News release:

The Mental Health Foundation today released a report showing problem anger is left untackled in the UK, despite widespread concern about aggression, family breakdown and physical and mental health problems linked with anger.

The Boiling Point report says chronic and intense anger has been linked with heart disease, cancer, stroke, colds and flu as well as depression, self-harm and substance misuse. Higher levels of anger are related to lower levels of social support and higher stress levels. Anger is more likely to have a negative effect on relationships than any other emotion.

Problem anger goes largely untackled unless someone commits an aggressive criminal act, when a court may refer them to anger management training. The charity says we are intervening too late and could save many lives from being damaged if we tackled it earlier.

The report records interviews with GPs, psychologists and providers of anger management courses and therapies as well as a public attitude survey.  A literature review carried out for the report suggests anger studies and interventions for problem anger are in their infancy.

Anger is a vital emotion, and essential to our survival, but it can become entrenched in everyday life for some people, interfering with their thinking, feeling and behaviour and creating misery for themselves and others.

A public attitude survey carried out for the report shows widespread concern. Almost two thirds (64 percent) of participants in a YouGov* survey of just under 2,000 adults say that people in general are getting angrier. According to the poll almost a third of us (32 percent) have a close friend or family member who has trouble controlling their anger. More than a quarter (28 percent) of us worry about how angry we sometimes feel; and one in five (20 percent) of us say we have ended a relationship or friendship with someone because of how they behaved when angry.

Polling also found strong public support for tackling problem anger – 84 percent of us believe that people should be encouraged to seek help if they have problems with anger. But 58 percent wouldn’t know where to go.

Dr Andrew McCulloch, Chief Executive of the Mental Health Foundation said:

“In a society where people can get help for depression and anxiety, panic, phobia, eating disorders and a range of other psychological and emotional problems, it seems extraordinary that we are left to fend for ourselves when it comes to an emotion as powerful as anger. We need to be able to recognise when anger is damaging our lives, ask for help and receive it.

In the media and in mainstream life we hear a lot about road rage and many other types of rage. Our polling shows that the general public understands what’s going on. But as a society we have yet to tackle the issue. It is the elephant in the room in mental health. This is not about excusing bad behaviour, but about helping individuals and communities to take responsibility. Tackling it won’t be simple or straightforward, but the benefits could be enormous.”

The report says that problem anger is not a mental illness in itself but many of the everyday tools used in mental health - such as talking therapies - can be applied to help people cope better with anger. But the area has been neglected by researchers, clinicians and policy makers. Consequently people who might benefit enormously from learning how to manage their anger better are not encouraged to come forward, or when they do, they may be offered little or nothing in the way of useful support.

Boiling Point says that there are already a number of schemes run by public, private and voluntary sector organisations that are targeted at helping people deal with problem anger. But most of these are post-hoc interventions to which people are referred because they have already got into considerable trouble at home, work or with the police and criminal justice system.

The unanticipated demand for executive coaching has necessitated an increase in the Coaching Faculty at Anderson & Anderson. Nancy Anderson, MSW, LCSW and President of Anderson will begin training coaching clients in July, 2008. Nancy will work exclusively at the Brentwood office.

Nancy Anderson

Nancy Anderson is the president of Anderson & Anderson, and the quiet impetus of its success. Nancy earned a Bachelor’s and two Master’s Degrees from UCLA, where she has also been a member of the clinical staff at the Neuropsychiatric Institute. She is licensed in Educational Psychology and Clinical Social Work in the state of California.

Currently, Nancy maintains a clinical psychotherapy practice at Anderson & Anderson and is available for consultation on educational or family issues that can not be addressed by an anger management program. She also works as an educational psychologist for The John Thomas Dye School in Bel Air. Although she is certified in anger management, her primary involvement at Anderson & Anderson has been as the CEO.

John Elder, MA, MFT, CAMF who is a long time Anderson & Anderson Faculty member will begin providing coaching in San Bernardino County and cities in easy commute from Loma Linda, CA.

John Elder, M.A., M.F.T.

Mr. Elder has been a facilitator and Anderson & Anderson Faculty for several years. John is one of the most interesting members of our faculty. He has assisted in writing most of our material and is a regular contributor to our blog and website. John is the author of the Anger Management Pyramid as well as the new meditation relaxation tape which will both be listed on our website very shortly. He is also the co-author of our new publication, “The Practice of Control”.

Since the new JCHAO standards for “disruptive physicians” were imposed on all Health Care Organizations in April, 2008, Anderson & Anderson, Vanderbilt University Department of Psychiatry and the PACE Program at the University of California at San Diego have emerged as the principal providers of Executive Coaching/Anger Management for Physicians in the nation. Anderson & Anderson is the only nationally recognized provider to use a structured, non-psychiatric assessment tool for mandated and self referred physicians.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management
http://www.andersonservices.com/
http://www.aaamp.org
http://www.linkedin.com/in/geoanderson
www.anger-management-resources.org

After a row about queue-jumping, a 57-year-old man called Kevin Tripp lies dying in a Sainsbury’s. As his life ebbs away, children are ushered out by their parents.
Tony Virasami, a 37-year-old who was called to the store by his girlfriend, is charged with his murder. How many lives were ruined that day? And all because an incident that would once have been dealt with by someone clearing their throat, or raising an eyebrow, is now settled by someone getting killed.

They call it “shopping rage” but that trivialises something that is eating us alive - a willingness to resort to extreme violence at the slightest provocation.

Where someone would once have raised their voice, they now raise their fists. Incidents that would have, at the very worst, led to A&E now end in the graveyard, the court and jail. What is wrong with us? When did a country famous for its humour, patience and tolerance give itself over to this uncontrollable rage?

Rage is our distinguishing feature now. And we know it can erupt at any moment. You see it everywhere. You risk your life if you object to anti-social behaviour.

Respect is a term we hear a lot of, but there is precious little of it for old people, for women, for children. It feels like all the old taboos have been discarded, all the old borders that made this a decent society have been torn down.

Where there was once indulgence for the old lady with her change in a shop, there is now impatience.

Where there was once tolerance for the ways of others, there is now murderous fury.
And where there was once politeness, there is now rudeness.
Something about us has coarsened. The man who died in Sainsbury’s would not have perished even 10 years ago. The man who assaulted him would not so readily have resorted to extreme violence. This is not looking back at the good old days through rose-tinted contact lenses - we really were a gentler, more tolerant people.

I don’t know how you get it back, that lost England where someone would behave on a train or bus just because someone rattled their newspaper. But I know it is gone.

We all feel the frustrations of the modern world and impatience with people who get in our way.

What has changed is the total lack of restraint. We have lost the fear of our father, of the police, of the courts, our fear of being punished.

So anger is allowed to erupt like a volcano because someone cuts us up at the lights, or looks at us the wrong way, or upsets our girlfriend at the checkout.

It’s ironic that the generations who knew the suffering of war and poverty are less angry than the brats of peace and prosperity.

Reports suggest the man who died wasn’t the one who jumped the queue. He was patiently waiting his turn.
The wrong man was punished for a petty crime.
But that’s anger for you. When the red mist descends, all you can think about is violence. The brain switches off. And a man dies from massive head injuries because a woman was slighted and her boyfriend’s response was immediate, uncontrollable rage.

And why? Because someone thought they might have to wait an extra 90 seconds to pay for their oven chips.
We have to get back to the old ways when respect was something you showed others, not something you furiously demanded yourself.

Where the old and the weak and the young were tolerated, not regarded with impatience.
And where a man could face the everyday frustrations of life without losing his rag.
Where there was once tolerance for the ways of others, there is now murderous fury. What is wrong with us?

Philo Holland
Senior Broadcast Journalist
BBC Radio Five Live
Manchester
Phone: x44290 (0161 244 4290)
Fax: 07921 648 298
E0mail:  [mailto:philo.holland@bbc.co.uk]
Mail: Room 1044, BBC, Manchester, M60 1SD 
          909 & 693 AM, digital radio & TV, & online at http://www.bbc.co.uk/fivelive

What is everyone so furious about?

There are some crimes so abhorrent that they make us wonder what kind of society we’re living in. One of these bouts of soul-searching was prompted last week when a man died after a violent altercation in a Sainsbury’s supermarket in south London; a man and a woman have since been charged with the murder of Kevin Tripp, a 57-year-old engineer from Colliers Wood.

Shocked friends and neighbours paid tribute to Mr Tripp, who suffered from ME, and there were harrowing pictures of the grief-stricken mother of his five-year-old daughter. Several lives have been destroyed by an event that was over in seconds; and another child - like those of 47-year-old Garry Newlove, who was kicked to death in Warrington last August - now has to grow up without a father.

Mr Newlove was set upon when he challenged a group of youths who were damaging a car. Mr Tripp was attacked, apparently after a row over queue-jumping. What was especially shocking about these deaths is that none of us expects to encounter lethal violence in everyday life; we don’t kiss friends and partners as they set off for Sainsbury’s, crossing our fingers and desperately hoping they’ll survive the trip. Crime surveys tell us that such extreme events are relatively rare, but the phenomenon they appear to highlight - an increase in aggressive behaviour - is causing great concern.

Evidence is accumulating that substantial numbers of people have never learned to handle anger and aggression, reacting with uncontrolled fury to minor setbacks and slights. Alcohol sometimes plays a part, but random flare-ups of hostile behaviour have become so common that we talk about road rage, air rage, even supermarket rage, as if they’re a normal part of existence. Drive slowly when you’re lost, and you may see the faces of other drivers contort with anger as they try to overtake. Politely ask the person in front of you on a plane not to slam their seat back, and they’re likely to let loose a stream of abuse. Adults’ behaviour affects children, and bullying is now a major problem in schools, where kids use text messages and the internet to persecute vulnerable classmates.

None of this is happening in a vacuum, and it’s perverse to deny a link with popular culture. Everywhere I look, aggressive behaviour is egged on and validated, whether it takes the form of celebrities being encouraged to slag each other off or TV chefs haranguing their hapless assistants. Big Brother and its spin-offs choose contestants with poor impulse control and an infantile desire for attention, cynically pitting them against each other.

Nowhere is this more evident than on the internet. Many people who post messages seem to be in the grip of ungovernable rage, which they direct randomly at anyone who comes into their sights, like drunks lurching out of a pub in search of a punch-up.

The urge to insult, hurt and humiliate is clearly part of human nature. But it is more prevalent in some cultures than others, and its antidote is just as well-known. Civilised societies don’t reward displays of petulance and anger. They certainly don’t pretend that good manners are only for wimps.

Philo Holland
Senior Broadcast Journalist
BBC Radio Five Live
Manchester
Phone:  x44290 (0161 244 4290)
Facsimile: 07921 648 298
E-mail: [mailto:philo.holland@bbc.co.uk]
Mail: Room 1044, BBC, Manchester, M60 1SD 
          909 & 693 AM, digital radio & TV, & online at http://www.bbc.co.uk/fivelive

Anderson & Anderson, the leading provider of anger management classes, training, and executive coaching services, will be publishing and sending the updated Los Angeles County Court Provider’s List to all court houses in L.A. County by July 1st. This list will be in effect from July 1st until December 31st, and another list will be published for 2009.

Each provider on the list has been trained by Anderson & Anderson to help clients address and manage the following five areas: Anger Management, Stress Management, Communication Styles, Emotional Intelligence (Empathy), and Orientation to Change. It is required that all providers on our list purchase a number of materials from Anderson & Anderson, materials that are crucial to the professionalism and structure of the Anderson & Anderson anger management model. Providers, like all professionals who offer counseling or skill-enhancement services, are required to remain current with knowledge and any changes or enhancements that are made for the curriculum. This involves 16 hours of continuing education per year. We will provide specific details for anyone who wants to become certified and listed on our court providers list.

One thing that each provider must keep in mind is that Anderson & Anderson does not guarantee a number of referrals that a provider will receive when listed on the court list. While the courts in L.A. County exclusively refer mandated clients to our list (each mandate will receive a copy of the list), there is no guarantee that a provider will receive phone calls. It is the responsibility of the provider to market his or her services to the general public. We recommend internet marketing as a primary strategy. Anderson & Anderson provides marketing information and advice during our three-day training seminars. In addition, much of this information is included in the Suggested Guide for Anger Management, the facilitator’s guide that is included in both the live trainings and the home study versions. Please call Anderson & Anderson if you have any additional questions.

Rasheed Ahmed
Office Manager
Anderson & Anderson®
The Trusted Name in Anger Management
Ph: 310-207-3591  
Fax: 310-207-6234
http://www.andersonservices.com